Eyes that bulge, or protrude out of their normal position, could be an indication of a serious medical condition. Proptosis and exophthalmos are the medical terms used to describe bulging eyes.
In most cases, the white part of the eye should not be visible over the iris (top of the colored part of the eye). If the white of your eyes show between the iris and your upper eyelid, this is often considered abnormal bulging. Treatment will be based on the diagnosis. However, some individuals have the hereditary trait of prominent eyes, in which the white part of the eyes is more prominent and visible.
Bulging in only one eye of a child is a particularly serious sign. Seek medical attention immediately.
The most common cause of bulging eyes is hyperthyroidism (an overactive thyroid). Your thyroid gland is located in the front of your neck. It releases several hormones that control metabolism. Hyperthyroidism is when your thyroid releases too many of these hormones over a short and concentrated or long period.
An autoimmune disorder called Graves disease is the most common cause of hyperthyroidism and of bulging eyes. Tissues around the eye become inflamed, thus creating the bulging effect. Anyone can get Graves disease, but women over the age of 20 are most at risk.
Other causes of bulging eyes include:
- hyperthyroidism caused by medications used for other conditions
- bleeding behind the eye caused by injury
- glaucoma (fluid pressure in the eye that causes optic nerve damage)
- hemangioma (an abnormal buildup of blood vessels in the internal organs or in the skin)
- histiocytosis (a group of syndromes in which there is an abnormal increase in the number of immune cells)
- leukemia (cancer of the white blood cells)
- neuroblastoma (cancer of the nerve tissue)
- orbital cellulitis (infection of tissues around the eye)
- periorbital cellulitis (infection of the eyelid or the skin around the eye)
- rhabdomyosarcoma (cancerous tumor of the muscles that are attached to bones)
- vascular disorders (disorders affecting the circulatory system)
Bulging in only one eye of a child is a particularly serious sign that requires immediate medical attention.
If you have a bulging eye or eyes, make an appointment for a thorough medical exam as soon as possible. Be prepared to provide your doctor with your complete medical history. Your doctor will also want to know the specifics of your symptoms, such as:
- When did you first notice that your eyes were bulging?
- Have they gotten worse since that time?
- Do you have any other symptoms? If so, what are they?
- Do you take any prescription or over-the-counter medications or supplements?
After a physical exam, your doctor may order additional tests. These may include:
- slit-lamp exam (uses a low-power microscope along with a high-intensity light to examine the structures at the front of the eye)
- blood tests (to check for thyroid diseases)
- imaging tests, including computed tomography (CT) or magnetic resonance imaging (MRI)
Any treatment for bulging eyes will depend entirely on the cause, but may include:
- eye drops
- corticosteroids to ease inflammation
- surgical procedures to repair damaged arteries and veins
- surgery, chemotherapy, and radiation to treat tumors
Treatment for thyroid disease, including Graves disease, may include:
- beta-blockers, such as propranolol
- antithyroid medications
- surgery to remove the thyroid
- radioactive iodine to destroy the thyroid, thereby stopping hormone production (this treatment can occasionally make eye problems worsen)
- replacement hormones (if surgery or radiation was performed to destroy the thyroid)
Eye problems associated with hyperthyroidism can be worse for people who smoke, so quitting may help to lessen eye bulging.
Bulging eyes may lower self-esteem or cause self-consciousness in affected individuals, so emotional support is important as well.